Osseodensification: A new era of implant osteotomy

Abstract

Successful osseointegration is achieved by the primary and secondary stability of dental implants. The primary stability of any successful dental implant is dependent on the quality and quantity of bone. Besides the experience of the surgeon and bone-implant contact (BIC)at the time of implant placement is equally important. Similarly the high insertion torque helps in obtaining primary stability. Several techniques have been introduced to enhance the bone quality and quantity in an attempt to achieve primary implant stability. One commonly used technique is under preparation of the osteotomy site by use of a drill that is one size small than the implant diameter. However undersized osteotomy compromises the healing between the bone and implant and hampers secondary biological fixation. Osteotomes have also been used in an attempt to increase the bone width buccolingually and improve the peri-implant site bone density. However studies have reported that there was only an increase in bone density at the periapical area with no influence on the lateral margins and primary stability of the implant. The associated trabecular fracture with osteotome bone condensation may further damage the osteocytes and cause extension microfracturesand delayed healing. Finally,the success of implant therapy relies largely on the stability and mechanical durability of the prosthesis delivered to the patient. As such several modifications, reinforcements and techniques have been suggested over the years to optimize the same. The latest in line is the non-subtracting osteotomy by specially designed Densah burs. This article aims to review the theory, advantages and disadvantages of this technique as compared to traditional osteotomy.